Thaís Rodrigues Villa

Visual attention in children with migraine: a controlled comparative study

The aim of this study was to evaluate the visual attention of children with migraine and compare it with a control group. Thirty migrainous children and 30 controls without headache were subjected to a visual attention assessment with Trail Making Tests (TMT) A/B, Letter Cancellation Test, and the Brazilian computerized test Visual Attention Test, third edition. The migraine group was evaluated after 2 days without headache. The migraine group had an inferior performance compared with the control group on TMT A (P = 0.03) and B (P = 0.001), and more errors on tasks 1 (P = 0.032) and 2 (P = 0.015) of the Visual Attention Test, presenting difficulty with selective and alternate attention. Attention is a neurological function that depends on structures such as the brainstem, cerebral cortex and the limbic system and on neurotransmitters such as dopamine and noradrenaline. The neurochemical aspects involved in the physiopathology of migraine and attention mechanisms probably predispose these children to visual attention deficits.

Migraine and cognition in children: a controlled study

OBJECTIVE Evaluate the cognitive functions of children with migraine and compare them to A control group. METHOD 30 migraineur children and 30 control group children without migraine, age ranging from 8 to 12 years old, were subjected to a cognitive functions assessment with Wechsler Intelligence Scale for Children (WISCIII). RESULTS Although both groups had a normal cognitive performance, children with migraine had significantly worse scores compared to the control group in the subtests of Information, Arithmetic, Vocabulary, Object Assembly and in the Indexes of Perceptual Organization, Resistance to Distraction and Processing Speed. CONCLUSION Children with migraine had impairment in some cognitive functions such as attention, memory, information speed, and perceptual organization compared to the control group.

Amitriptyline and aerobic exercise or amitriptyline alone in the treatment of chronic migraine: a randomized comparative study

UNLABELLED To compare the preventive treatment benefits of amitriptyline and aerobic exercise or amitriptyline alone in patients with chronic migraine. METHOD Sixty patients, both genders, aged between 18 and 50 years, with a diagnosis of chronic migraine, were randomized in groups called amitriptyline and aerobic exercise or amitriptyline alone. The following parameters were evaluated: headache frequency, intensity and duration of headache, days of the analgesic medication use, body mass index (BMI), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores. RESULTS In the evaluated parameters, was observed decrease in headache frequency (p=0.001), moderate intensity (p=0.048), in headache duration (p=0.001), the body mass index (p=0.001), Beck Depression Inventory (p=0.001) and Beck Anxiety Inventory scores (p=0.001), when groups were compared in the end of third month. CONCLUSION In this study, the amitriptyline was an effective treatment for chronic migraine, but its efficacy was increased when combined with aerobic exercise.

Visual Attention in Children With Migraine: The Importance of Prophylaxis.

This study aimed to compare the visual attention performance of children newly diagnosed with migraine, children undergoing migraine prophylaxis, and a healthy control group. Eighty-two children aged 8 to 12 years were divided into 3 groups: untreated migraine (n = 30), migraine prophylaxis (n = 22), and control (n = 30). All were subjected to a visual attention assessment with the Trail Making Test parts A and B, Letter-Cancellation Test, and the Brazilian Visual Attention Test 3rd edition. Although performance in attention tasks was within the normal range in all groups, children with untreated migraine performed significantly worse in some visual attention tests than did the control children or children undergoing migraine prophylaxis. The migraine prophylaxis group performed as well as the control group. The deregulation of the neurochemical mechanisms underlying the physiopathology of migraine might induce visual attention deficits, but an effective prophylactic treatment might reverse migraine symptoms.

Prophylactic treatment of vestibular migraine

INTRODUCTION Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including β-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. OBJECTIVE To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. METHODS Review of medical records from patients with VM according to the criteria of the Bárány Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. RESULTS Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p<0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p<0.001) and headache (p<0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. CONCLUSIONS Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment.

Auditory Processing in Children with Migraine: A Controlled Study.

Background This study aimed to investigate central auditory processing performance in children with migraine and compared with controls without headache. Methods Twenty‐eight children of both sexes, aged between 8 and 12 years, diagnosed with migraine with and without aura, and a control group of the same age range and with no headache history, were included. Gaps‐in‐noise (GIN), duration pattern test (DPT), synthetic sentence identification (SSI) test, and nonverbal dichotic test (NVDT) were used to assess central auditory processing performance. Results Children with migraine performed significantly worse in DPT, SSI test, and NVDT when compared with controls without headache; however, no significant differences were found in the GIN test. Conclusions Children with migraine demonstrate impairment in the physiologic mechanism of temporal processing and selective auditory attention. In our short communication, migraine could be related to impaired central auditory processing in children.

Migrainous infarction as a complication of sporadic hemiplegic migraine in childhood

, migrain-ous infarction (MI) is a complication of migraine with aura. MI is diagnosed when one or more aura symptoms last longer than 60 minutes, and neuroradiological stud-ies demonstrate ischemic stroke that potentially explains the symptoms. Stroke should not be attributed to anoth-er disorder. The ICHD-II also defines sporadic hemiplegic migraine (SHM) as a subtype of migraine with aura asso-ciated with fully reversible motor weakness in association to the typical aura symptoms (visual, sensory or dyspha-sic aura). Unlike familial hemiplegic migraine (FHM), fa-milial history of migraine with motor weakness in first- or second-degree relatives is absent. MI in childhood is very rare and epidemiological studies are scarce

Prednisone in withdrawal therapy following medication overuse headache

Dear Sir We have read the article ‘Prednisone vs. placebo in withdrawal therapy following medication overuse headache’ by Pageler et al. in the February issue of Cephalalgia and found it extremely interesting (1). The basis of medication overuse headache treatment continues to be the interruption of all overused medications. The high prevalence of this condition in headache clinics results in many patients suffering from withdrawal symptoms and headache intensification (2). Due to this remarkably uncomfortable process, many patients fail to complete withdrawal therapy (3). Any method that enables patients to tolerate this therapy will be welcome. We would like to comment on some aspects of the article in order to assist and simplify future studies. Although intended to be a pilot study, the study population and protocol should have been described in more detail, in order to allow the precise reproduction of the study and to avoid dispute. Exclusion criteria should include the presence of active peptic ulcer and other severe disorders, subsequently increasing safety prior to the use of such a high dose of prednisone in a larger population. These additional criteria were used in two previous studies that included a high dose of prednisone in withdrawal therapy, but in a lower and tapering dose (4, 5). We are not considering the hypothesis of peptic ulceration caused by steroids, whose evidence is fogged by conflicting data (6). Rather, we have in mind that a supraphysiological dose of steroids may inhibit the healing of preexistent lesions, which can be caused by the overused medication (2). Besides, it is tempting to speculate that nine patients do not constitute a meaningful sample size to demonstrate adverse events and to prove the safety of the therapy of choice. Moreover, the article should have clearly described the method used to record headache characteristics before withdrawal therapy. Retrospective reports on chronic pain patients indicate a tendency to present inaccurate information and suggest that reliance on medication increases the divergence between reported and actual pain severity (7). Studies in children and adults imply that a combination of clinical interviews and the use of diagnostic headache diaries provides a more precise diagnosis (both quantitatively and qualitatively) than a clinical interview alone (8, 9). Our experience with children and adolescents, comparing chronic daily headache severity prior to and following the use of a headache diary, has confirmed the superior diagnostic potential of the combination of the two methods (especially in a population such as this, prone to recall bias, placebo effect and previous overestimation) (10). A reliable baseline headache severity should have been documented in a diary or calendar in order to reduce bias and to increase the accuracy of description, which would strengthen the comparison after withdrawal therapy (11). Furthermore, if patients 6 and 10 (shown in Table 1 of Pageler et al.) (1) had been asked to complete a baseline headache diary, they would probably not have been included in the study or submitted to withdrawal therapy at all. In conclusion, we are optimistic about this approach (with a high dose of prednisone) to the treatment of withdrawal symptoms and headache intensification. There is still the need for a doubleblind, randomized, placebo-controlled study with the use of prednisone, which takes the abovementioned suggestions into consideration. A larger, multicentre, Phase III study has been initiated in various European centres (1), and these results are eagerly expected by patients who previously failed to complete withdrawal therapy and by their doctors.

Vestibular Migraine with Visual Aura and Olfactory Hallucination in Children: Two Case Reports

Background Approximately 3.9% children with migraine have olfactory hallucination which was defined as a perception of a smell without the substantial existence of any physical odor. Case We described the first two cases of children with vestibular migraine, presenting visual aura and olfactory hallucination. We reported two children with vertigo, visual aura, and olfactory hallucination before the headache who were responsive to topiramate. Conclusion The clinical description of olfactory hallucination presented some characteristics of migraine aura. Olfactory hallucinations could be inserted as a migraine aura in International Classification of Headache Disorders.